Maria Kathryn Souphis, DO

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

5101027301 Issued in MI

Practice address

309 E 11 Mile Rd # B
Royal Oak, MI 48067-2735

Phone

(947) 522-4900

Fax

(947) 522-4910

NPI assigned

May 22, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: msouphis749120@direct.hfhs.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• William Beaumont Hospital

  • General Acute Care Hospital
  • Royal Oak, MI
  • NPI 1083833875
  Medicare reassignment NPD
• William Beaumont Hospital

  • Hospitalist Physician
  • Royal Oak, MI
  • NPI 1811044878
  NPD
• William Beaumont Hospital

  • General Acute Care Hospital
  • Grosse Pointe, MI
  • NPI 1932396017
  NPD
• William Beaumont Hospital

  • Physician Assistant
  • Royal Oak, MI
  • NPI 1164471983
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1590105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687824000000",
    "number": "1821611922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26901 BEAUMONT BLVD STE 3D",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480333849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309 E 11 MILE RD # B",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480672735",
            "telephone_number": "947-522-4900",
            "fax_number": "947-522-4910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOUPHIS",
        "first_name": "MARIA",
        "middle_name": "KATHRYN",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-05-22",
        "last_updated": "2023-06-27",
        "certification_date": "2023-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "5151014268",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "5101027301",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "msouphis768769@direct.beaumont.edu",
            "affiliation": "N",
            "address_1": "309 E 11 Mile Rd # B",
            "city": "Royal Oak",
            "state": "MI",
            "country_code": "US",
            "postal_code": "480672735",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jennifer Soucie, CRNA
• Maya Soufan, MBBS
• Dana Soukup, MD
• Stephen J Soules
• Soulspace Wellness Center
• Olivia Rose Souphis, MD
• Ravikumar Sourirajan, PT, DPT
• Marcy Lee Soutar, RN
• Southeast Michigan Neurosurgery PLLC
• Jacob Brad Souva

• Pediatrics Physician in Royal Oak, MI
• Providers in Royal Oak, MI by specialty
• Pediatrics Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.